P1661: THROMBOSIS AND BLEEDING IN CANCER PATIENTS WITH COVID-19: A DIFFICULT BALANCE
Authors: Abdulrahman Al Raizah, Naveed Qureshi, Zied Aljubour, Afnan Alnajjar, Anas Alhason, Abdullah S. Al Saleh, Mohsen Alzahrani, Ayman Hejazi, Ahmed Alaskar
Journal: HemaSphere (2023)

Topic: 34. Thrombosis and vascular biology - Biology & Translational Research Background: Several observational studies have reported a high rate of thrombotic events in patients infected with coronavirus disease 2019 (COVID-19). Cancer increases the risk of thrombosis as well. However, data about thrombotic complications in ambulatory and admitted patients with cancer and COVID-19 are limited. Aims: The aim of this study was to estimate the rate of thrombotic and bleeding events in cancer patients diagnosed with coronavirus disease 2019 (COVID-19). Methods: This was retrospective single center study of 209 patients with active cancer with confirmed COVID-19 diagnosed between January 2021 and July 2022. Active cancer defined as diagnosis of cancer or receiving treatment for cancer within six months, or recurrent locally advanced or metastatic cancer. Patients were excluded if they lost follow up before day 90. Patients were classified as admitted group if they were admitted within 90 days of COVID-19 diagnosis and ambulatory group if they were not admitted. Venous thromboembolism (VTE) included all symptomatic or incidentally diagnosed cases of pulmonary embolism (PE), deep vein thrombosis (DVT) and thrombosis in unusual sites (cerebral, mesenteric, portal, splenic, hepatic, and renal veins). All VTEs were confirmed radiographically by appropriate imaging. Screening for VTE in asymptomatic patients was not performed. Arterial events included cerebrovascular accidents (CVAs), mesenteric ischemia, limb ischemia and myocardial infarction (MI) were confirmed by the appropriate clinical, laboratory and imaging modality. Bleeding events were classified as major and nonmajor based on the definition of International Society of Thrombosis and Haemostasias (ISTH). Data were collected manually by chart review. The rates of VTE, bleeding, arterial are summarized as proportions, with the corresponding 95% confidence intervals (CIs). Statistical analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). Informed consent was waived. Results: Total of 209 patients were included. Mean age 54±16 SD. Majority were admitted (55.5%, n=116). Twenty sex patients required ICU admission. Median length of stay 8 days. The most common cancer is breast cancer 51(24 %). Most of the admitted patients received pharmacological prophylaxis (80 %, n=93).The most frequently prescribed regimen was enoxaparin (40 mg once daily) (44 %). Nineteen patients were diagnosed with Venous thromboembolism (VTE) 9 % (95% CI, 5.5–13.8). The rate in the admitted group was 12.9% (95% CI, 7.4–20.4), all VTE occurred during admission except 2 happened after discharge. Rate of VTE in the ambulatory group was 4.3 % (95% CI, 1.1–10.6). Majority of the admitted group who had the VTE were on were on enoxaparin 40 mg once daily (n=8) and none of the outpatients were on anticoagulant prophylaxis. No patients had arterial events. Three patients in the admitted group had bleeding and no bleeding occurred in outpatients’ group. The overall rate of bleeding is 1.4% (95% CI, 0.3–4.0). The bleeding rate in the admitted group was 2.5% (95% CI, 0.5–7.3). At the time of bleeding, one patient was on full dose UFH, 1 was on enoxaparin BID and 1 was not on any anticoagulant. Summary/Conclusion: In this study, we found a high rate of VTE in cancer patients with COVID-19 in both admitted and ambulatory patients. The current study suggests that intensification of anticoagulation therapy beyond the standard of care in cancer patients with COVID-19 may be needed not only during admission but also post discharge and probably for ambulatory patients as well. This would best be evaluated in a randomized controlled study.Keywords: Cancer, COVID-19, Bleeding, Thrombosis